Question: My son is constantly chewing or sucking on things. He is 12. His shirt, pens or pencils, his fingers, bottle caps – whatever he can get his hands on. I tell him to stop and he stops for 5 seconds and then his hands just go back to his mouth. You can see that he trying to fight the impulse but it just keeps coming every few seconds and then he forgets and does it. We got some spray on deodorant and sprayed it on his hands so he would taste it and remember so he would be more conscious of the problem and that helped a bit but it has not solved the problem. I am worried that people will make fun of him for sucking on his fingers in class. What can we try?

Dr. Lani Chin Says...:

Thanks for your post. I'll do my best to try to answer your question.

It sounds like your son may be trying to express himself through his chewing and sucking. Have there been any changes recently in your family? Your son may be trying to find a way to soothe himself or discharge some anxiety he is feeling. I would recommend you schedule an appointment with his general practitioner to see if there is anything physical going on that may result in this behavior. You can also ask his general practitioner for a referral to a Child Psychologist who might be able to help your son explore new ways to express himself.

For an immediate difference, try to give less attention to the behavior your don't want him to do. Sometimes attention can be a form of reinforcement whether it be positive or negative. Try to ignore the behavior as best you can unless he is harming himself and give more praise or attention to other behaviors. For example, if he expresses how he is feeling when he wants to chew or suck on something, reward him in some way. This way he will learn that if does something other than the behavior you want to decrease, he will have more positive interactions with you. Additionally, you can try to teach him when he is nervous or anxious to take a walk or do something else with his hands like play the piano or fold a paper airplane. Sometimes children have an excess of energy that they may not know what to do with.

Good luck to you and your son.

Question: I have been a skin picker since I was 10 years old so for about 5 years. I pick my cuticles mostly but also blemishes on my face and at my scalp. How long would it take to break this habbit. Like for smokers it takes 3 or 4 to break the nicotine habbit and then it gets easier. How long would I have to completely stop picking for before the urge would go away?

Jill Edwards Says...:

An interesting question, because most of the information that would decide the answer is held with you. But what is really on my mind is that the skin picking is probably not the issue that needs tackling. This is a habit you have had for a long time and there are probably some circumstances or potentially some anxieties which have supported it and kept it going. So because of that I would suggest that you access some counselling and see how improving your life circumstances and the way you think about your self and your circumstances can be helpful to you.

I know you have compared this to a cigarette addiction and I am glad that you have felt that although it may take a few go's you can move on from this habit. cigarettes of course give a low level sort of upper, so I am wondering what sort of a lift skin picking does for you, is it a mild form of self injury. Is there enough pain for that. Does it distract you from other thoughts or feelings you don't want to have.

Ii don't know how it affects you. do other people complain about it, do you think it is childish and want to feel more adult. I do suggest that you find some counselling to help you with this issue as it is possibly a simple habit which sits on top of a number of other issues around your self confidence and the way your present yourself.

If you cannot do this, then you will have to examine yourself to see what part it plays, whether you really want to stop. When you stop, then in your home you can use gloves to help you to stop.

I wish you a life free of your habit and a new way forwards.

Question: Does coffee have any influence on OCD? My brother drinks like 10 cups a day but swears it has no effect on things. I am not so sure…

Katie Brooks Says...:

Hello there-

First of all, everyone is different. Your brother may not
experience negative side effects from caffeine at this moment. It is also
possible that he has been drinking coffee for quite some time and does not know
the difference. That being said, over forty research studies have
shown that excessive caffeine can be harmful to your health.

Here are just a few
of the effects that caffeine can cause in the general population:

• Rapid or irregular heartbeat
• Restlessness
• Nervousness
• Insomnia
• Flushed face
• Twitching or trembling
• Distracted thoughts and speech
• Physical agitation
• Nausea
• Light-headedness
• Diarrhea
• Mood swings

These symptoms make up the "fight or flight" reactions designed
to protect you from harm. Excessive amounts of caffeine can prompt the body's
fight or flight response even though no real danger exists. This overactive
fight or flight response can contribute to anxiety.

Caffeine
exasperates Anxiety, Insomnia, and Panic Attacks.  Since
OCD is an anxiety disorder, and caffeine causes anxiety, it would be worthwhile
for your brother to quit or decrease his caffeine intake.  My guess is he would see a significant
decrease in symptoms.   

It
sounds as if your brother is very addicted to caffeine.  Although caffeine seems to be one of the
least dangerous substances, a substance it is. 
Addiction is addiction.  Your
brother may report not being agitated by the coffee because he is protecting
his addiction and does not prefer to give it up.

Unfortunately, you cannot force anyone to
give up a bad habit, but you can educate.  It might be a good idea to refer him to a
therapist who can educate him and teach him how to manage/ cope with his
disorder in a healthy way.  Cognitive
Behavioral Therapy has been shown to be the most effective form of therapy for
OCD.  If you have any further questions
or would like to make a phone appointment please visit my website goodtherapysandiego.com.

Question: Is it ocd if I have to repeatedly lock my car over and over again. I will lock it and then wlking in to the shop or whatever and then I will have to turn back and relock it and then because there are two buttons on my car locker I start wondering if I accidentally unlocked it so I will need to lock it again…and on it goes until I eventually start to feel very self conscious for standing like a crazy man in the parking lot locking my car over and over again. Even when my wife tells me I have done it I still need to go back and do it again. I don’t do anything else crazy like this but this is starting to become very weird and beyond my control.

Katie Brooks Says...:

Hello-

It sounds as if you are experiencing some
disturbing repetitive checking, which is a component of OCD.  According to
your description, you do feel like it is excessive, but unless the obsessions
and compulsions are lasting more than an hour per day and/ or are causing a
serious disruption in your daily functioning, I would not diagnose you with Obsessive
Compulsive Disorder.  Oftentimes there
are self-help workbooks that you can buy on Amazon that will educate you
further on OCD and also give you some strategies for coping.  Unfortunately,
mental illness is progressive.   You may want to be proactive and see a
therapist who practices Cognitive Behavioral Therapy, specifically Exposure and
Response Prevention.  A therapist will
help you manage the compulsion to check your lock and help you discover any obsessive
thoughts that are triggering that compulsion.   If you have any further
questions please contact me for a private phone session or appointment at
GoodTherapySanDiego.Com. 

Warmest Wishes,

Katie Brooks, LCSW

The Criteria for OCD is as follows:

A. Either obsessions or compulsions:

Obsessions as defined by (1), (2), (3), and (4):

(1) recurrent and persistent thoughts,
impulses, or images that are experienced at some time during the disturbance,
as intrusive and inappropriate and that cause marked anxiety or distress

(2) the thoughts, impulses, or images are not
simply excessive worries about real-life problems

(3) the person attempts to ignore or suppress
such thoughts, impulses, or images, or to neutralize them with some other
thought or action

(4) the person recognizes that the
obsessional thoughts, impulses, or images are a product of his or her own mind
(not imposed from without as in thought insertion)

Compulsions as defined by (1) and (2):

(1) repetitive behaviors (e.g., hand washing,
ordering, checking) or mental acts (e.g., praying, counting, repeating words
silently) that the person feels driven to perform in response to an obsession,
or according to rules that must be applied rigidly

(2) the behaviors or mental acts are aimed at
preventing or reducing distress or preventing some dreaded event or situation;
however, these behaviors or mental acts either are not connected in a realistic
way with what they are designed to neutralize or prevent or are clearly
excessive

B. At some point during the course of the
disorder, the person has recognized that the obsessions or compulsions are
excessive or unreasonable. Note: This does not apply to
children.

C. The obsessions or compulsions cause marked
distress, are time consuming (take more than 1 hour a day), or significantly
interfere with the person’s normal routine, occupational (or academic)
functioning, or usual social activities or relationships.

D. I another Axis I disorder is present, the
content of the obsessions or compulsions is not restricted to it (e.g.,
preoccupation with food in the presence of an Eating Disorder; hair pulling in
the presence of Trichotillomania; concern with appearance in the presence of
Body Dysmorphic Disorder; preoccupation with drugs in the presence of a
Substance Use Disorder; preoccupation with having a serious illness in the
presence of Hypochondriasis; preoccupation with sexual urges or fantasies in
the presence of a Paraphilia; or guilty ruminations in the presence of Major
Depressive Disorder).

E. The disturbance is not due to the direct
physiological effects of a substance (e.g., a drug of abuse, a medication) or a
general medical condition.

Question: I have an addictive personality. I am in cocaine recovery. I have had a problem with chewing my fingernails since I was a kid. Are these things related in the brain somehow? Seems weird that I can stop smoking crack but I can’t stop biting my nails.

Dr. Lani Chin Says...:

Thanks for your post.  I will do my best to help you understand how your nail biting and cocaine addiction may be related.

First of all, congratulations on staying sober.  Choosing to quit using any substance is not an easy decision. 

Using cocaine and biting your nails are two ways you've been using to cope with issues that have come up in your life.  At some point in your life, you realized that using cocaine or biting your nails made you feel better.  As a result, you continued to do either instead of using other coping skills (i.e. writing, exercising, etc.).  So try to think about your cocaine use and nail biting as two separate activities that make you feel different for different reasons.  When using cocaine, you probably feel carefree and numb.  The things that bothered you became insignificant because you had a a body high and the pain you were in probably went away.  When biting your nails, you are doing something that you find soothing and probably distracting.  Both activities take you away from feeling distress and both activities help you cope with things you don't want to feel or think about. 

Hope this answers your question and helps you understand what's going on.  I wish you the best of luck in your recovery and with the rest of your life. 

Question: My daughter has Trichotillomania (she is a hair puller). My daughter is 15 and she was able to hide it from me for a long time. I would see her pulling her hair while watching TV but I never knew it was a serious problem, I just thought it was a bad habit and I would scold her to stop. I have only known about it that it was a serious problem for a few weeks. I took her to our family doctor and he said if she couldn’t stop doing it on her own he might prescribe antidepressants to her. I do not want her to start off on drugs so young. I have a solution but my husband thinks it is wrong. I would like to ask you about it. What if we just shaved her head completely and kept it shaved for long enough for her to break her bad habit? I know this sounds extreme but I think she could pull it off looks wise and she could think of a reason to tell her friends and it would be better than starting her off on a lifetime of needing drugs.

Dr. Lani Chin Says...:

Thank you for your post.  Your daughter is lucky to have you on her side.

First and foremost, I would recommend individual and family therapy for your daughter.  Trichotillomania is an impulse control disorder.  As such, you daughter is likely having a difficult time with coping.  She has found comfort in pulling out her hair and probably finds the behavior quite soothing.  It would benefit her greatly to learn some new coping mechanisms and individual therapy can be the perfect setting for that.

I want to address your question.  You asked about shaving her head.  Is this something that she is on board with?  If you shave her head without her consent, you will likely exacerbate the problem.  Most of the time, hair pulling is about feeling in control of something.  If you shave her hair and she doesn't want you do that, you will make the problem worse and her symptoms will likely increase.  Additionally, since trichotillomania is an impulse control disorder, she will likely find another maladaptive way of coping with her emotions.

You also state feeling concerned that your daughter will be "on a lifetime of needing drugs."  This is a common misconception about medication.  An anti-depressant can be taken on a short term basis for your daughter to feel better and begin to address the problems that are contributing to her symptoms.  This is not a guarantee that she will need medication for the rest of her life.  Again though, if your daughter begins therapy, she will learn coping skills that will likely decrease the need for her to be on medication.

Hope I've answered your questions.  Good luck to you and your daughter.

Question: I like to go clubbing. I got into the habit of picking at my skin and grinding my teeth from doing a lot of ecstasy and coke and speed. Now I can’t stop even though I am not really into that scene any more and don’t really do drugs very often. My dentist wants me to wear a retainer at night to protect my teeth because it’s so bad I have ground most of my enamel off. I pick the skin around my scalp and I do it whenever I am distracted now. I have these gross sores and I have to wear a headband all the time to hide them. I have tried everything I can think of to stop myself but it’s so frustrating because whenever I forget to think about it I just start doing it thoughtlessly again. Help!

Jim LaPierre Says...:

It sounds like while you were under the influence you developed some habits that you associate with a sense of nervousness. I'm wondering how often you experience feelings of anxiety while you're clean and sober? Glad you got out of that scene with X and coke but the habits remain. Wearing a retainer makes sense and keeping your hands occupied (stress ball, holding a pen in your dominant hand, doing any kind of craft work) will help you to avoid picking.

I'd urge you to consider how mindful you are of your emotions and to notice feelings of anxiousness, nervousness, or worry and consider coping with these more adaptively. Anything we want to change requires greater awareness - journaling is good for this. I'd also encourage you to have a physical check up with your doctor and ask specifically about the condition of your scalp and see if there are treatment options to help the healing.

Question: I think I need some help because I can never control my hands. I always had really bad acne. I started getting zits bad in like grade 7 and I’ve been living with pimples for years. Now I’m a senior in high school and actually my acne is really a lot less than it used to be. But the problem is I can’t stop squeezing zits and picking at my face, even spots that don’t even have a zit but kind of feel like they might be something in there, I squeeze and pick at those too. My mom was always telling me to stop picking at my face. She said it was just going to make things get infected and worse. I did not but maybe I should have. Now my acne is getting kind of under control but my face looks even more gross than it ever did. Now it’s my squeezing and picking that’s doing the damage. I am not joking when I say that I make myself bleed almost every day from picking. I know this, but I can’t seem to stop myself from picking. I’ll be watching TV and I won’t even know what I am doing but when I notice I see that I am picking at some imaginary spot on my face and before exam times and stuff when things get kind of stressed around here, my picking gets way worse. I have been reading on the internet and I think that I have skin picking disorder. But I am not sure what exactly I am supposed to do to make it go away. I don’t think I’m going to be seeing a shrink or whatever because money is pretty tight around the house. Is there a drug or something that I can take to make this go away?

Jim LaPierre Says...:

Kudos to you for having the courage to reach out and ask for help. Dealing only with what's on the surface never seems to work well whether it's literally or figuratively. Popping zits is a release in a sense - you're trying to make something you don't want there go away. You seem to be doing this during times of stress or anxiety and so I would ask you is there anything else you do to let go of tension/stress and get release of negative emotions.

We don't ever really just stop doing something unhealthy - we replace it. Example - when folks quit smoking they usually start doing something else (chew gum, eat more, use a nicotine patch). If you're going to change this behavior - keep your hand occupied with something else besides your skin, journal your real feelings, and if counseling is an option (depending on health insurance it may be low cost) pursue it.

Best of luck to you

Question: I have a hard time getting to sleep because I have to check everything in the house a number of times before I can force myself to stay in bed. And often once I am in bed I will have to get out to go and check on the kids again and to make sure I didn't forget to lock all the doors and windows etc. Does this mean I have OCD? I also have this annoying habit of counting things, like seconds or steps and once I get started it is hard for me to stop. I have always done the counting thing but I am going through a stressful period as I ave lost my job and now my craziness is much worse than it ever has been before.

David Shannon Says...:

Obsessive Compulsive Disorder (OCD) is an anxiety disorder, characterized by repetitive thoughts (obsessions) and/or behaviors you feel pressured to repeat over and over (compulsions).  To be diagnosed with OCD, the obsessions and compulsions must be present for at least an hour a day, and cause significant problems in a person's life, affecting things like relationships, jobs, or health.  OCD can be triggered by stress, which fits with your current circumstances.  However, it is also thought to be a chronic condition, and may require monitoring and treatment for the rest of one's life.  This does not mean that the symptoms are always present, at least not to the same degree.  But the tendency or susceptibility to obsessive thinking and compulsive behaviors persists, even as the symptoms may vary in strength, frequency, and the effect they have on your life.  The key to living with any chronic condition is to find the most effective ways to manage the symptoms, so that they have the least negative impact on one's life.  Such compulsive thoughts and behaviors can also be symptoms of other conditions such as depression and anxiety.

Both counting, and compulsively checking things repeatedly, are symptoms of OCD.  You say that you have always done the counting thing, which may indicate that at least mild symptoms of OCD have been going on for a quite a while.  But that is mostly an annoyance.  Feeling compelled to check things over and over, however, is making it difficult to get to sleep, and that can negatively affect both your health, and your ability to cope with your situation in a positive and productive way.  You may have intrusive and repetitive thoughts that make you anxious, and your compulsive behaviors may be a way to try to control that anxiety.

OCD is treated with both medications and psychotherapy, particularly what is known as cognitive behavioral therapy.  CBT teaches you how to notice negative thinking, and to replace or modify specific thoughts that are causing you problems.  It is widely used to treat depression, anxiety, and some personality disorders.

Medications are intended to correct imbalances of chemicals in your brain, known as neurotransmitters.  Inadequate serotonin has particularly been associated with OCD, as well as dopamine and others.  These same neurotransmitters play a role in depression, anxiety, and other conditions.  The antidepressants known as selective serotonin reuptake inhibitors (SSRI's) are often prescribed to treat OCD.  They may take weeks or months to become fully effective.  Each person can react differently to a particular medication, so it may be necessary to try more than one, before finding what works for you.  It would be understandable if you are also depressed and anxious about being unemployed, with all the practical difficulties that result from that.  Finding the right medication(s) might help alleviate all of those conditions.  I would encourage you to talk about this with your doctor.  They may want you to see a psychiatrist, but most primary care physicians are knowledgeable and experienced in prescribing these meds.  There may also be other physical problems going on that could be affecting both your mood, your behaviors, or your sleep.

A combination of medications and psychotherapy is often the most effective.  So you may want to see a therapist as well.  You could start with either a doctor or a therapist, but problems sleeping might best be dealt with first by the doctor.  In the short term they might prescribe an anti-anxiety medication or a sleeping pill, to give some relief, while you give an SSRI enough time to work.  If you are using alcohol or other chemicals, you should talk about that with both your doctor and your therapist.  You may be trying to self-medicate.  Those things might actually be at cross-purposes, or at least not work as well as specific prescribed drugs might.  Alcohol does not mix well with many medications, and often makes them them less effective.

There are some things you can do yourself now, to start managing your thinking and compulsive behaviors.  I suggest making a list of all the things you get up to check on.  As you make your rounds, check off each item on the list.  The next time you feel like you have to check all those things, have the list next to your bed, and notice that you have recently done so.  This may help reduce your anxiety about them.  It may not be enough to keep you from repeating the process, but you may find that you do not have to do it as many times before you are able to fall asleep.  If you reduce the repetitions from 10 to 3, or from 30 to 20, or even have to do it one less time, you should consider it a success.  If you do this every night, you may gradually need to do the whole routine less than before.  You might also notice that some items are more important than others, so you may eventually be able to shorten the both list and the routine.

I also suggest writing down all your thoughts that go through your mind, that may contribute to your compulsive behaviors.  Some of those thoughts will repeat frequently, if not every time, and those would make up the obsessive pattern.  Just getting them out of your head by writing them down may make thinking about some of them less necessary.  Make a list on the left, with another column on the right, and write down things you might say to yourself that are more accurate, more positive, or at least more balanced than each item on the left.  That is a basic CBT technique and something you can get started on by yourself.  Working through them with a therapist will help you become better at noticing and challenging such thoughts.  A therapist will likely notice more instances of such thinking than you do at first.  They can help you interrupt the thought process long enough to do something about it.  They can help you find the replacement thoughts that will be most effective.  The more you do this, the less power such negative thinking will have over you, and you will find yourself doing it less.

Medications and psychotherapy may not "cure" you completely.  But they are ways to manage your symptoms.  As you become better at that, the symptoms will interfere less with your life.  And you will undoubtedly feel better.  Best wishes, both for relief from these symptoms, and for getting your life back on track.

Question: Do I have OCD if I have compulsions to do certain things but I don't really have any excessive anxiety. I don't know how to explain really, but for example, one thing I have to do all the time is whenever I am traveling by car I have to click my teeth whenever I pass a streetlight or electric pole. Or whenever I walk on a side walk I have to tap the side of my leg whenever I walk over a crack. It gets embarrassing and hard to explain to others so I'd like to stop but I can't and I don't understand why I do this? Is this some form of compulsive disorder?

Dr. Lani Chin Says...:

It sounds like you have some compulsions, however, I'm unsure if they can be classified as a disorder.  Do you feel like these behaviors have somehow impacted your day-to-day functioning?  It sounds like you're embarrassed when you're around others but are these feelings overwhelming enough to limit the time you spend with others because you don't want to explain what you're doing?  I would recommend individual therapy to talk more about these compulsions and what they mean to you.  Oftentimes, people may engage in compulsions to exert control over some part of their lives because they feel out of control/powerless in other parts.  If you are in the Los Angeles area, I would be happy to help you explore this further: www.drlanichin.com.  If you are not, I recommend you look for another professional to help you better understand your behaviors.  Good luck.